¿Feliz....holidays?

In learning to speak better Spanish with my patients, at some point, the conversation in the exam room goes beyond, “Usted tiene cataratas, necesita una cirugia para sacarlas”. In other words, with every patient encounter, there is—as there should be!—some dialogue not involving eyes or medicine or family history, but rather, everyday life!  

 ¿Cómo está USTED hoy?  ¿Cómo está la familia? ¿Fue a México este verano---pense que tenía planes de ir?

(How are YOU today? How is your family? Did you go to Mexico this summer?—I thought you had plans to go?)

It was always this general, everyday conversation—banter, if you will—that would contribute (and at times, still does) to my anxieties when treating a Spanish speaking patient.  

Why—you may ask? Well, it’s easy to get used to the rote dialogue of “¿Por qué Ud. está aquí? ¿Tiene problemas con los ojos? Abra el ojo. Siéntese aquí. Escribo una receta por lentes nuevos.  You memorize these phrases and repeat them.  You carry that cheat sheet (see blog entry, When in Rome) around in your mind and it becomes a part of you.  It’s a script that you can be sure of—one that dictates a certain, predicted response from the patient.  You fear deviating from it, because deviation from this preformed set of questions will invoke responses not expected.  Then you’ll have to really work to listen to understand the response, and in the end, despite your concentration, you may still not understand the patient’s answer completely.  Where do you go from here?  

I am talking about a script you can’t control.  How confident are you in your Spanish that you can talk nonchalantly about the weather?  Or a sports event? Or the patient’s plans for the summer?  After you’ve greeted the patient, and elicited the chief complaint, you find yourself washing your hands—and silence looms in the exam room.  How do you fill it?

I have found time and again that the best thing to do is to just dive right in. Don’t worry about grammatical errors, sentence structure—even incorrect vocabulary.  Don’t let your fear of “sounding foolish” prevent you from being social with your patient!

I’ll talk about the season, the weather, current events, travels, hobbies, interests and family.  When a holiday is approaching, I like asking the patients how they’re spending it, where they’re going, what they’re doing, etc.  Here are a few encounters I recently had with patients where the conversation centered around Thanksgiving:

Me: (while washing my hands and preparing my lenses for the exam) Bueno, ¿tiene Ud. planes para ... el día de pavo?   (my way of saying ‘Thanksgiving’ , the best I could do was “the day of turkey”!)

Patient: ¿el Día de Acción de Gracias? Mi nieta vive cerca de mí—voy a pasar el día con ella.

Me: ¡Qué bueno!

Patient: Y Usted, ¿qué hace?

Me: Mi familia no está lejos de mí. Tendré las festividades en mi casa, con mis padres, los padres de mi esposo, y mi cuñada y su esposo.

                                                                             *

Another example, this was toward the end of an exam-as the patient and his wife were getting ready to leave:

Me: Bueno, disfruten Uds. el... ¡holiday!

Patient:  Gracias, igual, Dios le bendiga y ¡feliz___________pavo!

(This patient happens to be a wonderful man, very kind, but his accent is heavy and he uses dialect phrases, both of which make it difficult for me to understand every word he says completely. But in the end, I heard the two words that mattered: feliz= happy, and pavo=turkey, and that’s all I needed to comprehend his good wishes.

Me: Gracias, como siempre, es un placer-

                                                                             *

And another conversation:

Me: ¿Cocina Ud. para la familia entera el día de Thanksgiving?

Patient:  ¡No—no más! Mi’ja tiene Thanksgiving para la familia. Voy a su casa y le ayuda a ella. Y Ud., ¿qué hace—cocina?

Me: Sí, este año cocino por todo—hago el pavo, y otras comidas tracidionales como... ¿cómo se dice ”candied yams”, “green bean y cebolla casserole” y “stuffing”?

Here, I just injected the English words, because I have never used the word yam or stuffing or green bean in Spanish and just had no idea how to even attempt translating.  Sometimes the patients understand me and may even teach me the correct terms in Spanish. Others may not understand exactly what I’m trying to say, but the basic idea is understood: “I make the turkey, and other traditional meals”.  

Incidentally, at the end of the day I always try to make it a point to look up the words I don’t know in Spanish.  This takes time and effort, but is absolutely necessary to increasing your vocabulary in any language. **You won’t remember a word you never see or use. **

This is what I found for:

Candied yams:    camotes carmelizadas  or batatas carmelizadas or ñames carmelizadas

Green bean and onion casserole:   guiso de ejotes y cebolla  or guiso de judías verdes y cebolla

or  cacerola de ejotes y cebolla or cacerola de judías verdes y cebolla

Stuffing: relleno

Always remember,  for the health care professional,  Spanish conversational vocabulary is just as important as knowledge of the medical terms and exam commands in the language.  I work hard to not let my insecurities about “sounding foolish”or “making mistakes” in Spanish prevent me from making patients feel at home in my exam room.   I want them to know that I am interested not only in their eye health, but in them as people.  People—after all, that’s what this profession is all about.  

                                                                            

When in Rome

You don’t have to be fluent in Spanish to perform a successful eye exam in Spanish.  Just as the mini-travel guides have short lists of key words and everyday phrases  to “get by” in a country  where English is not the primary language, so too exists a concrete list of words that should be mastered for the Spanish eye exam.  I put the following list together when I realized I was saying some of the same words over and over, and hearing the same words/responses from patients repeatedly.

By now you, my readers, know that my blog assumes you have an understanding of basic conversation in Spanish, both written and spoken. However,  the purpose of this particular entry is to focus on some basic medical ophthalmologic vocabulary that a person with even the most elementary knowledge of Spanish can use and understand with confidence in the clinical setting.  As discussed in my entry, Eye Has Not Seen,  just because you can get by in everyday speak in a language, doesn’t mean you have the vocabulary to tackle the medical or scientific arena.  The following list of phrases can serve as a “cheat sheet” of sorts by any health care professional doing an eye exam in the office.

I start with two questions below that are very simple, but elicit the reason for the visit.  In just a few short words, you can ascertain why the patient is there and what you have to look for on exam.  For example, the vision may be bien, fine, but the eyes may be bothering the patient ie.--me pican, they itch me.  The vision and the eyes may both be bien, in which case the patient is likely visiting you for a routine ophthalmology check-up.  Or, the eyes may be bien,  but the vision is borrosa, blurry. So the patient would then need a refraction. 

¿Cómo está la visión?                                   How is the vision?

-bien                                                                   -fine

-borrosa                                                             -blurry

-empañada                                                         -hazy

-no es clara                                                        -it’s not clear

-doble                                                                 -double

                               

¿Cómo están los ojos?                                  How are the eyes?

-me arden                                                           -they burn

-me queman                                                       -they burn (as in, on fire)

-están lagrimeando                                             -they are tearing

-me pican                                                            -they itch

-me duelen                                                          -they hurt

Here are some phrases for the slit lamp exam, essentially telling the patient what to do and where to look:

Venga aquí, por favor.                                   Come here, please.

Ponga la barbilla aquí.                                  Put your chin here.

Pega la frente contra de la barra.                 Put your forehead against the bar.

Mire      -para frente.                                     Look      - in front.

             -para la izquierda.                                          -left.

             -para la derecha.                                           -right.

             -para arriba.                                                   -up.

             -para abajo.                                                    -down.

Mire aquí.                                                     Look here.

Siga  el dedo.                                               Follow my finger.

Bien, gracias.                                               Fine, thank you.

Puede sentarse atrás.                                 You can sit back.              

Todo está bien.                                             Everything is fine (everything looks normal)

Ud.  tiene cataratas                                      You have cataracts

                -ojos sanos/saludables                                   healthy eyes

                -ojos secos                                                     dry eyes

                -glaucoma                                                       glaucoma

                -degeneración macular                                   macular degeneration

                -desprendimiento de la retina                          retinal detachment

                -desgarro de la retina                                      retinal tear

                -retinopatía diabética                                       diabetic retinopathy

                -hemorragia vítrea                                          vitreous hemorrhage

                -ambliopía                                                       amblyopia

                -conjuntivitis                                                    conjunctivitis

                -infección                                                        infection

                -motas/manchas                                             floaters

                -orzuelo                                                           stye

                -pterigión                                                         pterygium

If your level of Spanish is limited in that you cannot explain the above conditions in detail, as, the patient likely will have questions and want an explanation, there are websites and reading material available in Spanish to accomplish just that.  Some sources require a nominal fee, others are available entirely for free. One such site is Spanish - Health Information Translations from healthinfotranslations.org which incidentally also contains Spanish translations of a variety of medical issues and procedures, not just those pertaining to ophthalmology.  This extremely invaluable website is maintained by the collective efforts of Ohio State University Wexner Medical Center, Mount Carmel Health System, OhioHealth and Nationwide Children’s Hospital, all of the central Ohio area.  

Again, familiarizing yourself with the key words needed for an eye exam in Spanish is absolutely essential for success.  Regardless of your language level, this cheat-sheet of words will help you hone in on the patient’s reason for the visit, get the most out of the exam and ultimately diagnose the problem.  Much the same way you would use a travel book of phrases to navigate your way through a restaurant in Venice or a hotel in Prague, knowledge of commonly used medical vocabulary in Spanish will help you move through your exam with confidence.  It’s been said, when in Rome, do as the Romans do.  But my feeling is, when in Rome, say as they say, and you’ll be appreciated for making the effort.

                                                                       

Courtesy: D Hromin

The Spanish Teacher

The following scenario commonly occurs when I am in the middle of performing an eye exam on a Spanish speaking patient, who happens to have brought along a family member or friend who is bilingual. 

Me: ¿Cuándo empezaron los síntomas?

Patient: Hace una semana.

Me: ¿Tuvo Usted estos síntomas en el pasado?

(loud interruption from the patient’s friend, sitting in the room while the exam is going on)

Friend: ¿TENÍA Usted los síntomas ….?”

Patient: No.

Me: ¿Usa Ud. lágrimas artificiales?

(Patient looks at her friend, quizzically)

Friend: GOTAS…..¿Usas GOTAS?

Patient: Una vez al día.

(later in the exam)

Me: Usted tiene una infección de los ojos se llama conjuntivitis.  Use esta gota cuatro veces al día (showing her a medicated eyedrop) y recuerde Usted---lavése los manos frecuentemente. Esta infección….

(interrupted by the friend again)

Friend: …lavése LAS MANOS frecuentemente….

Me (after a pause):…..las manos frecuentemente porque la infección es muy contagiosa. Va a regresar aquí en tres semanas para la próxima cita.  

To summarize, I suspect a patient has viral conjunctivitis based on her symptoms and I ask her more about the symptoms she is having.  While speaking, I make a mistake in my choice of verb tense and I mismatch a masculine article with a feminine noun.  The patient’s friend, without being asked, elects herself to correct me throughout the conversation.   

Depending on the day, how confident I feel and my overall mood,  I may view the Spanish-teaching friend of the patient as a help—or a hindrance—to me in the exam room.  I realize that anyone looking at this situation objectively may think, what’s the harm? If anything, the patient’s friend is there helping me learn – in essence—helping me hone my Spanish speaking skills.  

And this is true—I can think of many instances when my knowledge of Spanish or medical Spanish vocabulary increased because these generous people volunteered information:

“tubito”—when I was trying to find the word for “vial”, as in, the small vials preservative free tears are sold in

“parpadea”—when I was telling a patient to open and close his eyes, unable to remember the word for “blink”

“fomento tibio”—when I attempted to describe a towel soaked in warm water to apply as a compress and could come up with nothing more than “toalla caliente”

“mentón”—when I told a patient, “Ponga la barbilla aquí.” And he didn’t understand this alternate word ‘barbilla’ for “chin”

“signos de diabetes” to mean “signs of diabetes”not “señales de diabetes” because señales are traffic lights, not signs

As the patient’s physician, I want to be intelligent in my speech.   I don’t want to speak in choppy sentences or make grammar mistakes or mispronounce my words.   I want to sound professional and, in doing so, put the patient at ease.  I do have a certain level of insecurity when attempting to accomplish this in Spanish, my non-native language.  Even after all my years of learning, I realize that there is still much more to learn and I may or may not ever reach the vocabulary level of a native speaker.  But I do wish to try and at least sound articulate in Spanish.  To have someone else in the room, listening to and correcting my every word, in essence, virtually diagramming my sentences as they come out of my mouth, only serves to highlight my mistakes and insecurities—and there are moments when this can and does make me very uncomfortable.  Not to mention the fact that attention is drawn away from the patient and the exam.

One solution I have found that works particularly well for me is to put the Spanish Teacher “to the test”.    In other words,  when this person starts correcting me, I make a mental note of the correction---and begin asking  grammar questions right back at him/her!  

For example:

(talking to the patient)

Me: ¿Tuvo Usted los síntomas en el pasado?

Friend, aka, The Teacher: ¿…TENÍA los síntomas…?

Me (to The Teacher): Well, I used “tuvo”, the preterite past tense, because the action in the sentence happened once in the past--it wasn’t ongoing. But you’re saying I have to use the imperfect tense?

The Teacher:  I don’t know about preterite or imperfect. I just know what sounds right.  That’s how I would say it.

Me: Está bien. Gracias.

In this way, I acknowledge my mistake and take an opportunity to learn from it.  At the same time, I force the Teacher to explain herself (even if she doesn’t know exactly why she says the things she does in the language).  I believe this helps put me back in control of the exam—and allows me to give my undivided attention to the one who requires it: my patient!